ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Pharmacoepidemiology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1540576
This article is part of the Research TopicChallenges and Outcomes in Pediatric and Adult Kidney TransplantsView all articles
Time-dependent Impact of Immunosuppressant Regimens on Cardiovascular Outcomes in Kidney Transplant Recipients: A Nationwide Cohort Study
Provisionally accepted
- 1College of Pharmacy, Catholic University of Daegu, Gyeongsan, North Gyeongsang, Republic of Korea
- 2Daegu University, Gyeongsan, North Gyeongsang, Republic of Korea
- 3Yeungnam University, Gyeongsan, North Gyeongsang, Republic of Korea
- 4Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Seoul, Republic of Korea
- 5College of Pharmacy, The Catholic University of Korea, Bucheon, Republic of Korea
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Objectives: We aimed to evaluate the effect of different immunosuppressive regimens on the risk of major adverse cardiovascular events (MACEs) in kidney transplant recipients (KTRs).Methods: This retrospective cohort study used nationwide claims data from the Korean Health Insurance Review and Assessment Service from between 2010 and 2021. Immunosuppressive medications were analyzed as time-dependent variables, and the primary outcome was MACEs, defined as a composite of myocardial infarction, coronary revascularization, ischemic stroke, and allcause mortality.Results: A total of 8,056 KTRs were included in the analysis, with significant risk factors for MACEs identified as male sex, older age, longer dialysis duration, lower economic status, and greater comorbidity. At the time of the kidney transplant, 86.7% of the KTRs were administered standard triple therapy, after which various immunosuppressive regimens, including sirolimus-inclusive regimens, were employed. The risk of MACE was lower or comparable in KTRs standard triple therapy than in those receiving most other immunosuppressive regimens. However, corticosteroid withdrawal was associated with a significant reduction in cardiovascular risk, particularly in KTRs with preexisting diabetes or dyslipidemia.Conclusion: These findings suggest that early consideration should be given to minimizing steroid use in KTRs with dyslipidemia or diabetes to optimize cardiovascular outcomes.
Keywords: Kidney Transplantation, Immunosuppressive Agents, cardiovascular outcomes, Comorbidity, Time-dependent analysis
Received: 06 Dec 2024; Accepted: 23 Apr 2025.
Copyright: © 2025 Park, Choi, HWANG, Ah, Chung and Song. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yun-Kyoung Song, College of Pharmacy, The Catholic University of Korea, Bucheon, Republic of Korea
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